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• W1544582776 abstract "Pretransplant screening of potential organ donors and recipients is essential to the success of solid organ transplantation (1Avery RK Recipient screening prior to solid-organ transplantation.Clin Infect Dis. 2002; 35: 1513-1519Crossref PubMed Scopus (47) Google Scholar, 2Avery RK Prophylactic strategies before solid-organ transplantation.Curr Opin Infect Dis. 2004; 17: 353-356Crossref PubMed Scopus (27) Google Scholar, 3Delmonico FL Cadaver donor screening for infectious agents in solid organ transplantation.Clin Infect Dis. 2000; 31: 781-786Crossref PubMed Scopus (67) Google Scholar, 4Delmonico FL Snydman DR Organ donor screening for infectious diseases: Review of practice and implications for transplantation.Transplant. 1998; 65: 603-610Crossref PubMed Scopus (73) Google Scholar). The goals of pretransplant infectious disease screening are to identify conditions which may disqualify either donor or recipient; identify and treat active infection pretransplant; recognize and (if possible) define the risk of infection and develop strategies for preventing and mitigating posttransplant infection; and implement preventative measures, including immunizations (5Fischer SA Avery RK the AST Infectious Disease Community of PracticeScreening of donor and recipient prior to solid organ transplantation.Am J Transplant. 2009; 9: S7-S18Abstract Full Text Full Text PDF PubMed Scopus (125) Google Scholar). While there is general agreement on the major infections for which routine screening is performed, centers vary in the extent of infectious diseases investigation and the actions taken as a result. Potential recipients should be evaluated for infection risk by obtaining a thorough medical history, including details of prior infections, places of travel and residence, and exposures to animal and environmental pathogens. While all potential recipients undergo screening for the presence of infections such as HIV, hepatitis C (HCV) and cytomegalovirus (CMV), the detailed history can focus additional testing if necessary to mitigate and prevent the reactivation of latent infections posttransplant. Pretransplant recipient screening also helps determine immunity to vaccine-preventable illnesses and may help with allocation of infected donor organs to recipients with known immunity to certain pathogens (6Schaffner A. Pretransplant evaluation for infections in donors and recipients of solid organs.Clin Infect Dis. 2001; 33: S9-S14Crossref PubMed Scopus (55) Google Scholar). The pretransplant period is an ideal time for detailed counseling of the recipient and his/her family about safe food handling and the risk of infection associated with pets, travel and hobbies such as gardening and woodworking. Infection prevention approaches including hand hygiene, prophylactic antimicrobials, postexposure prophylaxis and updating of immunizations should be addressed as well. A variety of pathogens may be transmitted by transplantation (Table 1) (7Avery RK Ljungman P Prophylactic measures in the solid-organ recipient before transplantation.Clin Infect Dis. 2001; 33: S15-S21Crossref PubMed Scopus (72) Google Scholar, 8Fishman JA Nicolas CI Infection in organ transplantation: Risk factors and evolving patterns of infection.Infect Dis Clin N Am. 2010; 24: 274-283Abstract Full Text Full Text PDF Scopus (122) Google Scholar, 9Patel R Paya CV Infections in solid-organ transplant recipients.Clin Microbiol Rev. 1997; 10: 86-124Crossref PubMed Google Scholar, 10Gottesdiener KM Transplanted infections: Donor-to-host transmission with the allograft.Ann Intern Med. 1989; 110: 1001-1016Crossref PubMed Scopus (164) Google Scholar). Previous guidelines for pretransplant screening have been developed by a number of national and international multidisciplinary transplant groups (6Schaffner A. Pretransplant evaluation for infections in donors and recipients of solid organs.Clin Infect Dis. 2001; 33: S9-S14Crossref PubMed Scopus (55) Google Scholar,10Gottesdiener KM Transplanted infections: Donor-to-host transmission with the allograft.Ann Intern Med. 1989; 110: 1001-1016Crossref PubMed Scopus (164) Google Scholar, 11Kasiske BL Cangro CB Hariharan S et al.The evaluation of renal transplantation candidates: Clinical practice guidelines.Am J Transplant. 2001; 1: 3-95PubMed Google Scholar, 12Kasiske BL Ravenscraft M Ramos EL Gaston RS Bia MJ Danovitch GM The evaluation of living renal transplant donors. Clinical practice guidelines: Ad Hoc Clinical Practice Guidelines Subcommittee of the Patient Care and Education Committee of the American Society of Transplant Physicians.J Am Soc Nephrol. 1996; 7: 2288-2313Crossref PubMed Google Scholar, 13Rosengard BR Feng S Alfrey EJ et al.Report of the Crystal City meeting to maximize the use of organs recovered from the cadaver donor.Am J Transplant. 2002; 2: 701-711Crossref PubMed Scopus (277) Google Scholar, 14Chung RT Feng S Delmonico FL Approach to the management of allograft recipients following the detection of hepatitis B virus in the prospective organ donor.Am J Transplant. 2001; 1: 185-191Crossref PubMed Scopus (69) Google Scholar, 15Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients.Morb Mortal Wkly Rep. 2000; 49: 1-125PubMed Google Scholar). The Centers for Disease Control and Prevention (CDC) have published guidelines for the prevention of HIV transmission through transplantation (16Guidelines for preventing transmission of human immunodeficiency virus through transplantation of human tissue and organs.Morb Mortal Wkly Rep. 1994; 43: 1-17Google Scholar). These are in the process of revision in order to address updated knowledge of transmission of HIV and other bloodborne pathogens. In addition, the work of the ad hoc United Network of Organ Sharing/Organ Procurement and Transplantation Network (UNOS/OPTN) Disease Transmission Advisory Committee (DTAC) has helped define the risk of infection and disease transmission in organ donation in the United States and shape the discussion of screening and preventive measures (17Ison MG Hager J Blumberg E et al.Donor-derived disease transmission events in the United States: Data reviewed by the OPTN/UNOS Disease Transmission Advisory Committee.Am J Transplant. 2009; 9: 1929-1935Crossref PubMed Scopus (188) Google Scholar,18Ison MG Nalesnik MA An update on donor-derived disease transmission in organ transplantation.Am J Transplant. 2011; 11: 1123-1130Abstract Full Text Full Text PDF PubMed Scopus (207) Google Scholar).Table 1:Pathogens reported to be transmitted with solid organ transplantationBacteriaMycobacteriaStaphylococcus aureusMycobacterium tuberculosisKlebsiella speciesNontuberculous mycobacteriaBacteroides fragilisParasites/protozoaPseudomonas aeruginosaToxoplasma gondiiEscherichia coliStrongyloides stercoralisSalmonella speciesPlasmodium speciesYersinia enterocoliticaTrypanosoma cruziTreponema pallidumPneumocystis jiroveciBrucella speciesVirusesEnterobacter speciesCytomegalovirusAcinetobacter speciesEpstein–Barr virusLegionella speciesHerpes simplex virusNocardia speciesVaricella-zoster virusListeria monocytogenesHuman herpesvirus-6FungiHuman herpesvirus-7Aspergillus speciesHuman herpesvirus-8Candida speciesHepatitis B, DCoccidioides immitisHepatitis CCryptococcus neoformansHuman immunodeficiency virusHistoplasma capsulatumParvovirus B19Scedosporium apiospermumRabiesPrototheca speciesLymphocytic choriomeningitisZygomycetesvirusWest Nile virusBK virusHuman T cell lymphotropic virus (HTLV)-1/2 Open table in a new tab While conventional screening strategies are very effective in most cases, they are not a guarantee against donor-derived infections. There have been a number of high-profile incidents of donor-transmitted infection reported in recent years, including rabies (19Srinivasan A Burton EC Kuehnert MJ et al.Transmission of rabies virus from an organ donor to four transplant recipients.N Engl J Med. 2005; 352: 1103-1111Crossref PubMed Scopus (375) Google Scholar), lymphocytic choriomeningitis virus (20Fischer SA Graham MB Kuehnert MJ et al.Transmission of lymphocytic choriomeningitis virus by organ transplantation.N Engl J Med. 2006; 354: 2235-2249Crossref PubMed Scopus (431) Google Scholar), West Nile virus (21Iwamoto M Jernigan DB Guasch A et al.Transmission of West Nile virus from an organ donor to four transplant recipients.N Engl J Med. 2003; 348: 2196-2203Crossref PubMed Scopus (580) Google Scholar), HIV (22Simonds RJ Holmberg SD Hurwitz RL et al.Transmission of human immunodeficiency virus type 1 from a seronegative organ and tissue donor.N Engl J Med. 1992; 326: 726-732Crossref PubMed Scopus (576) Google Scholar, 23Ison MG Llata E Conover CS et al.Transmission of human immunodeficiency virus and hepatitis C virus from an organ donor to four transplant recipients.Am J Transplant. 2011; 11: 1218-1225Abstract Full Text Full Text PDF PubMed Scopus (105) Google Scholar, 24Ahn J Cohen SM Transmission of human immunodeficiency virus and hepatitis C virus through liver transplantation.Liver Transpl. 2008; 14: 1603-1608Crossref PubMed Scopus (61) Google Scholar) and HCV (23Ison MG Llata E Conover CS et al.Transmission of human immunodeficiency virus and hepatitis C virus from an organ donor to four transplant recipients.Am J Transplant. 2011; 11: 1218-1225Abstract Full Text Full Text PDF PubMed Scopus (105) Google Scholar,24Ahn J Cohen SM Transmission of human immunodeficiency virus and hepatitis C virus through liver transplantation.Liver Transpl. 2008; 14: 1603-1608Crossref PubMed Scopus (61) Google Scholar), which have renewed discussion of the process of organ donor screening. In addition to DTAC, other transplant and public health community initiatives have helped guide practice in the hope of developing a more robust sentinel network to detect and respond to donor transmission events in a more timely manner (20Fischer SA Graham MB Kuehnert MJ et al.Transmission of lymphocytic choriomeningitis virus by organ transplantation.N Engl J Med. 2006; 354: 2235-2249Crossref PubMed Scopus (431) Google Scholar,25Fishman JA Strong DM Kuehnert MJ Organ and tissue safety workshop 2007: Advances and challenges.Cell Tissue Bank. 2009; 10: 271-280Crossref PubMed Scopus (36) Google Scholar, 26Strong DM Seem D Taylor G et al.Development of a transplantation transmission sentinel network to improve safety and traceability of organ and tissues.Cell Tissue Bank. 2010; 11: 335-343Crossref PubMed Scopus (20) Google Scholar, 27Fishman JA Greenwald MA Kuehnert MJ Enhancing transplant safety: A new era in the microbiologic evaluation of organ donors?.Am J Transplant. 2007; 7: 2652-2654Crossref PubMed Scopus (29) Google Scholar, 28Humar A Fishman JA Donor-derived infection: Old problem, new solutions?.Am J Transplant. 2008; 8: 1087-1088Crossref PubMed Scopus (16) Google Scholar). This guideline summarizes current opinions on screening for bacterial, mycobacterial, fungal, parasitic and viral infections in the donor and recipient (Table (2Avery RK Prophylactic strategies before solid-organ transplantation.Curr Opin Infect Dis. 2004; 17: 353-356Crossref PubMed Scopus (27) Google Scholar) (5Fischer SA Avery RK the AST Infectious Disease Community of PracticeScreening of donor and recipient prior to solid organ transplantation.Am J Transplant. 2009; 9: S7-S18Abstract Full Text Full Text PDF PubMed Scopus (125) Google Scholar). More detailed discussions of these infections, including posttransplant monitoring, prophylaxis and treatment are found in other sections of these Guidelines. Due to the lack of expansion in the available organ pool despite steady increases in the need for organ replacement for end-stage diseases, it has become necessary to consider marginal donors, including those with active infection at the time of donation, higher risk serologic profiles, or a social history indicating potential exposure to bloodborne pathogens such as HIV or HCV. The natural history and treatment options for donor infection, the urgency of transplantation of a vital organ into a recipient and the likelihood (or lack thereof) of another organ offer for the patient on the transplant waiting list must all be weighed in determining the acceptability of the potentially infected donor. The differences in screening of the living donor and the deceased donor are largely based on the different time constraints during which the evaluation must take place. For the living donor, it is often possible to treat active infection and delay transplantation until the infection resolves. If there is a significant delay between donor evaluation and transplantation, interim evaluation may be indicated to rule out recently acquired infection. Clinical reassessment of the prospective living donor is indicated if clinical signs or symptoms of possible infection occur, particularly any unexplained febrile illness between the time of initial screening and the planned date of transplantation. The CDC has recommended that all living donors be rescreened with HIV serology and HIV nucleic acid amplification testing (NAT) prior to organ donation, to look for evidence of recently acquired infection (29Centers for Disease Control and Prevention. HIV transmitted from a living organ donor—New York City, 2009.Morbid Mortal Wkly Rep. 2011; 60: 297-301PubMed Google Scholar). Similarly, consideration should be given to repeating serologic HBV testing and HCV NAT in the potential living donor with risk factors for these infections. The screening of a prospective living donor includes a thorough medical and social history, physical examination, laboratory studies including serologic testing (Table 2) and radiographic workup as indicated by the donor’s history and the procedure to be performed. The medical history should include an assessment of previous infections, vaccinations, travel and occupational exposures, as well as the presence of behaviors posing risk for bloodborne or sexual pathogen exposure (e.g. drug use, sexual practices, incarceration). Living donors should be screened for syphilis, HIV, hepatitis B and C, and tuberculosis via a tuberculin PPD skin test or interferon-gamma release assay (IGRA) (II-2). If there is any suspicious donor history, additional testing may be warranted. Consultation with a transplant infectious disease specialist may help with determining additional workup, counseling and management while awaiting transplantation, should another living donor not be available.Table 2:Frequency utilized serologic tests for screening of donor and recipient prior to transplantationTests commonly obtained in both donor and recipientHuman immunodeficiency virus (HIV) antibodyHSV (herpes simplex) IgG antibody (at some centers)Cytomegalovirus (CMV) IgG antibodyHepatitis C (HCV) antibodyHepatitis B (HBV) surface antigen (HBsAg)Hepatitis B core antibody (HBcAb IgM and IgG, or total core antibody)Hepatitis B surface antibody (HBsAb)Rapid plasma reagin (RPR)Toxoplasma antibody (especially in heart recipients)Epstein–Barr virus (EBV) antibody (EBV VCA IgG, IgM)Varicella-zoster virus (VZV) antibodyOther screening measures for infectious diseasesPurified Protein Derivative (PPD) or interferon gamma release assay (IGRA) for latent TB infection in recipientsStrongyloides serology (for recipients from endemic areas)Coccidioides serology (for recipients from endemic areas)Trypanosoma cruzi serology (for donors and recipients from endemic areas)Serologies for tetanus, diphtheria, measles, mumps and pneumococcal titers as an aid to pretransplant immunization (at some centers)Optional screening measuresWest Nile virus serology or NATHHV-8 serologyBK serology (kidney donor and recipients)Nucleic acid amplification testing (NAT) for HIV, HCV, HBV, particularly in donors with high-risk social histories Open table in a new tab By contrast, the time frame for deceased donor evaluation is typically hours. Serologic workup is performed in laboratories associated with organ procurement organizations or similar screening agencies (hereafter referred to as OPOs) which operate on a 24-h basis to generate the data needed to determine donor suitability. Because of time constraints and the extensive geographic areas covered by some OPOs, testing is often limited to serologic methods that are rapid and routinely available. Because more sensitive testing may not be available, some infections, such as HIV and HCV, may be difficult to diagnose at an early stage, before the development of specific antibody (23Ison MG Llata E Conover CS et al.Transmission of human immunodeficiency virus and hepatitis C virus from an organ donor to four transplant recipients.Am J Transplant. 2011; 11: 1218-1225Abstract Full Text Full Text PDF PubMed Scopus (105) Google Scholar, 24Ahn J Cohen SM Transmission of human immunodeficiency virus and hepatitis C virus through liver transplantation.Liver Transpl. 2008; 14: 1603-1608Crossref PubMed Scopus (61) Google Scholar, 25Fishman JA Strong DM Kuehnert MJ Organ and tissue safety workshop 2007: Advances and challenges.Cell Tissue Bank. 2009; 10: 271-280Crossref PubMed Scopus (36) Google Scholar,30Humar A Morris M Blumberg E et al.Nucleic acid testing (NAT) of organ donors: Is the ‘best’ test the right test? A consensus conference report.Am J Transplant. 2010; 10: 889-899Abstract Full Text Full Text PDF PubMed Scopus (137) Google Scholar). Thus, a comprehensive social and medical history on the donor is required to identify risk for infections that might not be detected by serologic testing. Furthermore, certain infections may come to light only after the transplant has been performed, when results of routine procurement cultures of blood, urine and sputum become available. Increasingly, some OPOs are utilizing rapid molecular testing, particularly in high-risk potential donors, including NAT testing for HCV, HBV and HIV. A recent consensus conference on the utility of routine NAT testing was, however, inconclusive, largely due to concerns that testing is not feasible within the deceased donor timeframe in some areas, as well as concern that false positive test results in potential donors with no identified risk factors for infection might result in wastage of viable organs (30Humar A Morris M Blumberg E et al.Nucleic acid testing (NAT) of organ donors: Is the ‘best’ test the right test? A consensus conference report.Am J Transplant. 2010; 10: 889-899Abstract Full Text Full Text PDF PubMed Scopus (137) Google Scholar). Testing for certain pathogens with particular geographic significance such as Trypanosoma cruzi (Chagas’ disease), endemic mycoses and West Nile virus may be performed by some OPOs. If a deceased donor with uncertain risk is to be used, informed consent of the recipient should include the risk for infection transmission. The goal of evaluation of the potential living or decreased donor is to diagnose any infection with the risk of transmission to the recipient(s). Bacterial infections of the respiratory tract, urinary tract or the organ to be transplanted should be treated with documentation of resolution of infection prior to donation. The potential kidney donor with urinary tract infection should be investigated to rule out upper tract involvement. In the potential donor with a history or suspicion of prior bloodstream infection, a thorough investigation should be performed to insure that infection is not present in the target organ. Syphilis may be latent and asymptomatic in the donor and requires therapy if time permits. Syphilis has rarely been transmitted by transplantation, but it is not a contraindication to organ donation if each recipient is treated posttransplant with an appropriate course of penicillin (31Cortes NJ Afzali B MacLean D et al.Transmission of syphilis by solid organ transplantation.Am J Transplant. 2006; 6: 2497-2499Crossref PubMed Scopus (31) Google Scholar) (II-3). Deceased donors may harbor known or unsuspected bacterial infections (6Schaffner A. Pretransplant evaluation for infections in donors and recipients of solid organs.Clin Infect Dis. 2001; 33: S9-S14Crossref PubMed Scopus (55) Google Scholar,30Humar A Morris M Blumberg E et al.Nucleic acid testing (NAT) of organ donors: Is the ‘best’ test the right test? A consensus conference report.Am J Transplant. 2010; 10: 889-899Abstract Full Text Full Text PDF PubMed Scopus (137) Google Scholar, 31Cortes NJ Afzali B MacLean D et al.Transmission of syphilis by solid organ transplantation.Am J Transplant. 2006; 6: 2497-2499Crossref PubMed Scopus (31) Google Scholar, 32Doig RL Boyd PJ Eykyn S Staphylococcus aureus transmitted in transplanted kidneys.Lancet. 1975; 2: 243-245Abstract PubMed Scopus (59) Google Scholar, 33Kumar D Cattral MS Robicsek A Gaudreau C Humar A Outbreak of Pseudomonas aeruginosa by multiple organ transplantation from a common donor.Transplant. 2003; 75: 1053-1055Crossref PubMed Scopus (24) Google Scholar, 34Fernando ON Higgins AF Moorhead JF Letter: Secondary haemorrhage after renal transplantation.Lancet. 1976; 2: 368Abstract PubMed Scopus (12) Google Scholar, 35Nelson PW Delmonico FL Tolkoff-Rubin NE et al.Unsuspected donor Pseudomonas infection causing arterial disruption after renal transplantation.Transplant. 1984; 37: 313-314Crossref PubMed Scopus (60) Google Scholar). Attempts to rule out the presence of active infection should include obtaining a detailed history from the donor’s family, recent contacts and (if possible) primary care physician, as well as a complete review of medical records, vital signs, physical exam, radiographic studies and any available microbiologic studies. Blood cultures should be obtained to rule out occult donor bacteremia. Bacteremia with virulent organisms such as Staphylococcus aureus and Pseudomonas aeruginosa may result in early posttransplant sepsis or mycotic aneurysm formation at the site of allograft vascular anastomoses (32Doig RL Boyd PJ Eykyn S Staphylococcus aureus transmitted in transplanted kidneys.Lancet. 1975; 2: 243-245Abstract PubMed Scopus (59) Google Scholar, 33Kumar D Cattral MS Robicsek A Gaudreau C Humar A Outbreak of Pseudomonas aeruginosa by multiple organ transplantation from a common donor.Transplant. 2003; 75: 1053-1055Crossref PubMed Scopus (24) Google Scholar, 34Fernando ON Higgins AF Moorhead JF Letter: Secondary haemorrhage after renal transplantation.Lancet. 1976; 2: 368Abstract PubMed Scopus (12) Google Scholar, 35Nelson PW Delmonico FL Tolkoff-Rubin NE et al.Unsuspected donor Pseudomonas infection causing arterial disruption after renal transplantation.Transplant. 1984; 37: 313-314Crossref PubMed Scopus (60) Google Scholar, 36Freeman RB Giatras I Falagas ME et al.Outcome of transplantation of organs procured from bacteremic donors.Transplant. 1999; 68: 1107-1111Crossref PubMed Scopus (155) Google Scholar). Although a review of 95 bacteremic donors found no evidence of transmission when recipients were treated with antimicrobial therapy for a mean of 3.8 days posttransplant (36Freeman RB Giatras I Falagas ME et al.Outcome of transplantation of organs procured from bacteremic donors.Transplant. 1999; 68: 1107-1111Crossref PubMed Scopus (155) Google Scholar), the standard of care is to administer longer courses of therapy in the recipient (e.g. 2 weeks) if the donor is known to have been bacteremic with a virulent organism (II-2). In general, there is no reason to treat the recipient of an allograft from a deceased donor with nonbacteremic, localized infection not involving the transplanted organ, with the exception of meningitis, in which occult bacteremia frequently occurs (III). Organs have been successfully transplanted from donors with bacterial meningitis due to pathogens such as Streptococcus pneumoniae when appropriate antimicrobial therapy was administered to both the donor and recipients (37Lopez-Navidad A Domingo P Caballero F Gonzalez C Santiago C Successful transplantation of organs retrieved from donors with bacterial meningitis.Transplant. 1997; 64: 365-368Crossref PubMed Scopus (72) Google Scholar). Lung transplantation deserves special attention (38Ruiz I Gavalda J Monforte V et al.Donor-to-host transmission of bacterial and fungal infections in lung transplantation.Am J Transplant. 2006; 6: 178-182Crossref PubMed Scopus (103) Google Scholar). Donor bacterial colonization is common, as the lungs are in contact with the external environment, and the airways are colonized with multiple organisms, with increasing resistance noted in the hospitalized, critically ill potential organ donor. Donor bronchoscopy with cultures performed at the time of evaluation and/or procurement allows for the administration of antibiotics directed at these colonizing organisms, and can prevent invasive infection in the recipient (III) (7Avery RK Ljungman P Prophylactic measures in the solid-organ recipient before transplantation.Clin Infect Dis. 2001; 33: S15-S21Crossref PubMed Scopus (72) Google Scholar,8Fishman JA Nicolas CI Infection in organ transplantation: Risk factors and evolving patterns of infection.Infect Dis Clin N Am. 2010; 24: 274-283Abstract Full Text Full Text PDF Scopus (122) Google Scholar,38Ruiz I Gavalda J Monforte V et al.Donor-to-host transmission of bacterial and fungal infections in lung transplantation.Am J Transplant. 2006; 6: 178-182Crossref PubMed Scopus (103) Google Scholar). Allograft contamination may occur during organ procurement or processing (39McCoy GC Loening S Braun WE Magnusson MO Banowsky LH McHenry MC The fate of cadaver renal allografts contaminated before transplantation.Transplant. 1975; 20: 467-472Crossref PubMed Scopus (42) Google Scholar). Interpretation of organ preservation solution cultures is challenging, as contamination can occur (39McCoy GC Loening S Braun WE Magnusson MO Banowsky LH McHenry MC The fate of cadaver renal allografts contaminated before transplantation.Transplant. 1975; 20: 467-472Crossref PubMed Scopus (42) Google Scholar, 40Mossad SB Avery RK Goormastic M Hobbs RE Stewart RW Significance of positive cultures from donor left atrium and postpreservation fluid in heart transplantation.Transplant. 1997; 64: 1209-1210Crossref PubMed Google Scholar, 41Matignon M Botterel F Audard V et al.Outcome of renal transplantation in eight patients with Candida sp. contamination of preservation fluid.Am J Transplant. 2008; 8: 697-700Crossref PubMed Scopus (52) Google Scholar, 42Sauget M Verdy S Slekovec C et al.Bacterial contamination of organ graft preservation solution and infection after transplantation.Transpl Infect Dis. 2011; 13: 331-334Crossref PubMed Scopus (20) Google Scholar); however, infection transmission from contaminated solutions appears to be uncommon (39McCoy GC Loening S Braun WE Magnusson MO Banowsky LH McHenry MC The fate of cadaver renal allografts contaminated before transplantation.Transplant. 1975; 20: 467-472Crossref PubMed Scopus (42) Google Scholar,40Mossad SB Avery RK Goormastic M Hobbs RE Stewart RW Significance of positive cultures from donor left atrium and postpreservation fluid in heart transplantation.Transplant. 1997; 64: 1209-1210Crossref PubMed Google Scholar,42Sauget M Verdy S Slekovec C et al.Bacterial contamination of organ graft preservation solution and infection after transplantation.Transpl Infect Dis. 2011; 13: 331-334Crossref PubMed Scopus (20) Google Scholar). A report of kidney preservation fluid contamination with Candida species in eight recipients demonstrated that the risk of mycotic aneurysm rupture can be mitigated with appropriate antifungal therapy (41Matignon M Botterel F Audard V et al.Outcome of renal transplantation in eight patients with Candida sp. contamination of preservation fluid.Am J Transplant. 2008; 8: 697-700Crossref PubMed Scopus (52) Google Scholar). If a donor is determined to have active bacterial infection at the time of procurement, antibiotics should be administered to each recipient for at least 14 days for infections with Gram-negative bacilli, Staphylococcus aureus, or Candida species (II-3). A shorter course of therapy may be considered for less virulent organisms (III). Mycobacterium tuberculosis (TB) has been transmitted by transplantation; in the largest study to date (511 recipients), donor transmission accounted for approximately 4% of reported posttransplant TB cases (43Singh N Paterson DL Mycobacterium tuberculosis infection in solid-organ transplant recipients: Impact and implications for management.Clin Infect Dis. 1998; 27: 1266-1277Crossref PubMed Scopus (505) Google Scholar). Potential living donors should have PPD testing performed (a two-stage tuberculin skin test if from an endemic area) or TB interferon-gamma release assay (IGRA) testing (43Singh N Paterson DL Mycobacterium tuberculosis infection in solid-organ transplant recipients: Impact and implications for management.Clin Infect Dis. 1998; 27: 1266-1277Crossref PubMed Scopus (505) Google Scholar, 44Manuel O Humar A Preiksaitis J et al.Comparison of quantiferon-TB gold with tuberculin skin test for detecting latent tuberculosis infection prior to liver transplantation.Am J Transplant. 2007; 7: 2797-2801Crossref PubMed Scopus (105) Google Scholar, 45Aguado JM Torre-Cisneros J Fortun J et al.Tuberculosis in solid organ transplant recipients: Consensus statement of the Group for the Study of Infection in Transplant Recipients (GESITRA) of the Spanish Society of Infectious Diseases and Clinical Microbiology.Clin Infect Dis. 2009; 48: 1276-1284Crossref PubMed Scopus (208) Google Scholar); if either test is positive, additional testing should be performed to rule out the presence of active infection (III). Any donor with active tuberculosis should be excluded from donating until therapy has been completed and all signs of infection have resolved. A positive PPD is defined as the presence (at 48–72 h) of 5 mm or more" @default.
• W1544582776 created "2016-06-24" @default.
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• W1544582776 date "2013-03-01" @default.
• W1544582776 modified "2023-10-17" @default.
• W1544582776 title "Screening of Donor and Recipient in Solid Organ Transplantation" @default.
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